ICYMI: 'BROKEN' ARBITRATION PROCESS IS DRIVING UP PREMIUMS FOR FAMILIES AND EMPLOYERS

The following information was released by the America's Health Insurance Plans (AHIP):

In a new Washington Post op-ed, Paragon Health Institute's Brian Blase and Jackson Hammond underscore growing alignment among experts, stakeholders and policymakers across the political spectrum on the urgent need to protect Americans from egregious and costly provider-driven abuse of the No Surprises Act's arbitration (IDR) system.

Highlights include:

Provider-driven IDR abuse costs employers and consumers billions of dollars.

"A new Paragon Health Institute analysis found that the [independent dispute resolution] process is broken. Providers win roughly 85 percent of the time, and awards are typically far above market prices. In 2025, the median award was four times the median in-network rate. This has led to extreme discrepancies, such as when an in-network Manhattan surgeon made $12,767 for performing plastic surgery, while his out-of-network assistant received $210,000."

"Arbitrators make more money the more disputes they resolve, and because providers file over 99 percent of disputes, they are functionally arbitrators' clients."

"As providers learned that they almost always win, they began submitting increasingly high offers. American families ultimately finance excessive awards through higher premiums."

In addition to its direct costs, IDR abuse undermines affordable, in-network care.

"But the bigger problem may occur outside arbitration: High awards give providers leverage to demand higher in-network rates from insurers. Providers can now credibly threaten to remain out of network, where arbitration may pay them far more, unless insurers agree to inflated prices. This is a government-created distortion that raises health care costs for families."

"Private equity firms have swept into this space, building business models around keeping providers out of network and securing high payouts through arbitration."

What AHIP Is Saying: "The No Surprises Act was intended to protect patients and employers from surprise medical bills and lower overall healthcare costs. Common-sense, bipartisan policy solutions are needed to stop this gold rush by some out-of-network providers and private equity firms who abuse the law to maximize their profits while driving Americans' healthcare costs higher." Chris Bond, AHIP spokesman